Preexisting Cerebral Microbleeds on Susceptibility-Weighted Magnetic Resonance Imaging and Post-Thrombolysis Bleeding Risk in 392 Patients

Gratz, Pascal P.; El-Koussy, Marwan; Hsieh, Kety; Arx, Sebastian Werner von; Mono, Marie‐Luise; Heldner, Mirjam Rachel; Fischer, Urs; Mattle, Heinrich; Zubler, Christoph; Schroth, Gerhard; Gralla, Jan; Arnold, Marcel; Jung, Simon

doi:10.1161/strokeaha.114.004796

Cited by 59 publications

(63 citation statements)

References 25 publications

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“…Some of its aspects have been reported previously. [31][32][33][34] Patients were included in this analysis if (1) diagnosis of ischemic stroke was established with MRI before treatment, (2) they underwent endovascular treatment or bridging IVT and endovascular treatment, (3) they had an occlusion of the internal carotid artery or middle cerebral artery, and (4) MR was recorded into the picture archiving and communication system (as performed since 2004).…”

Section: Patients and Treatmentmentioning

confidence: 99%

Younger Stroke Patients With Large Pretreatment Diffusion-Weighted Imaging Lesions May Benefit From Endovascular Treatment

Gilgen

Klimek

Liesirova

et al. 2015

Stroke

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Background and Purpose— Lesion volume on diffusion-weighted magnetic resonance imaging (DWI) before acute stroke therapy is a predictor of outcome. Therefore, patients with large volumes are often excluded from therapy. The aim of this study was to analyze the impact of endovascular treatment in patients with large DWI lesion volumes (>70 mL). Methods— Three hundred seventy-two patients with middle cerebral or internal carotid artery occlusions examined with magnetic resonance imaging before treatment since 2004 were included. Baseline data and 3 months outcome were recorded prospectively. DWI lesion volumes were measured semiautomatically. Results— One hundred five patients had lesions >70 mL. Overall, the volume of DWI lesions was an independent predictor of unfavorable outcome, survival, and symptomatic intracerebral hemorrhage ( P <0.001 each). In patients with DWI lesions >70 mL, 11 of 31 (35.5%) reached favorable outcome (modified Rankin scale score, 0–2) after thrombolysis in cerebral infarction 2b-3 reperfusion in contrast to 3 of 35 (8.6%) after thrombolysis in cerebral infarction 0-2a reperfusion ( P =0.014). Reperfusion success, patient age, and DWI lesion volume were independent predictors of outcome in patients with DWI lesions >70 mL. Thirteen of 66 (19.7%) patients with lesions >70 mL had symptomatic intracerebral hemorrhage with a trend for reduced risk with avoidance of thrombolytic agents. Conclusions— There was a growing risk for poor outcome and symptomatic intracerebral hemorrhage with increasing pretreatment DWI lesion volumes. Nevertheless, favorable outcome was achieved in every third patient with DWI lesions >70 mL after successful endovascular reperfusion, whereas after poor or failed reperfusion, outcome was favorable in only every 12th patient. Therefore, endovascular treatment might be considered in patients with large DWI lesions, especially in younger patients.

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Section: Patients and Treatmentmentioning

confidence: 99%

Younger Stroke Patients With Large Pretreatment Diffusion-Weighted Imaging Lesions May Benefit From Endovascular Treatment

Gilgen

Klimek

Liesirova

et al. 2015

Stroke

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“…10 Presumed pathogenesis of CMBs was categorized in 3 groups: possible cerebral amyloid angiopathy (CAA), hypertensive, or undetermined. 5,18,24 According to Boston criteria, pathogenesis of CMBs was considered possible CAA if a strictly lobar (cortical or corticosubcortical) distribution of CMBs was found in patients aged ≥55 years. 24 Presumed hypertensive pathogenesis was defined if CMBs were located exclusively in deep regions, infratentorial regions, or both.…”

Section: Cmb Definition and Detectionmentioning

confidence: 99%

“…4 Previous studies have not clearly established whether the number of CMBs affects sICH risk. [10][11][12][13][14][15][16][17] Recently, Gratz et al 18 did not find evidence that higher CMB burden affects risk of sICH in patients treated with different revascularization procedures. Of note, <50% of patients received IVT exclusively.…”

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confidence: 99%

Number of Cerebral Microbleeds and Risk of Intracerebral Hemorrhage After Intravenous Thrombolysis

Dannenberg

Scheitz

Różański

et al. 2014

Stroke

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Background and Purpose-Cerebral microbleeds (CMBs) are found in a substantial proportion of patients with ischemic stroke eligible for treatment with intravenous thrombolysis. Until now, there is limited data on the impact of multiple CMBs on occurrence of intracerebral hemorrhage (ICH) after intravenous thrombolysis. Methods-Between 2008 and 2013, all patients receiving MRI-based intravenous thrombolysis were identified within our prospective thrombolysis register. Number of CMBs was rated on pretreatment T2*-weighted MRI by a rater blinded to clinical data and follow-up. Outcomes of interest were occurrence of symptomatic ICH (sICH) and parenchymal hemorrhage (PH). Results-Among 326 included patients, 52 patients had a single CMB (16.0%), 19 had 2 to 4 CMBs (5.8%), and 10 had ≥5 CMBs (3.1%). Frequency of sICH/PH was 1.2%/5.7% in patients without CMBs, 3.8%/3.8% in patients with a single CMB, 10.5%/21.1% in patients with 2 to 4 CMBs, and 30.0%/30.0% in patients with ≥5 CMBs, respectively (each P for trend <0.01). The unadjusted odds ratio per additional CMB for sICH was 1.19 (95% confidence interval, 1.07-1.33; P<0.01) and for PH was 1.13 (95% confidence interval, 1.03-1.24; P=0.01). Compared with patients without CMBs, both patients with 2 to 4 CMBs (P=0.02/P=0.02) and patients with ≥5 CMBs (P<0.01/P<0.01) had significantly increased odds ratios for sICH and PH, whereas in patients with a single CMB, odds ratios were not significantly increased (P=0.21/P=0.59). The association of CMB burden with sICH/PH remained significant after adjustment for possible confounders (age, age-related white matter changes score, atrial fibrillation, onset-to-treatment time, prior statin use, and systolic blood pressure on admission). Conclusions-Our findings indicate a higher risk of sICH and PH after intravenous thrombolysis when multiple CMBs are present, with a graded relationship to increasing baseline CMB number. (Stroke. 2014;45:2900-2905.)

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“…Выявлено достоверное повышение числа внутримозговых кровоизлияний у пациентов с 4 и более ЦМК при сравнение с группой без ЦМК. В другом исследовании [28] приводятся данные наблюдения за выборкой из 724 пациентов, проле-ченных ТЛТ, эндоваскулярной терапией или ТЛТ с последующим эндоваскулярным лечением. ЦМК при помощи МРТ в режиме SWI выявлены у 79 (20%) пациентов.…”

unclassified

“…Такие кровоизлияния могут осложнить течение ИИ в 20% [33]. По данным Соотношение числа ЦМК и внутримозговых кровоизлияний у пациентов, получивших тЛт [25] Число ЦМК Частота ВК, % (в скобках -клинически проя-вившиеся) 0 7,3 (2,9) 1-2 9,9 (4,9) 3-10 17,4 (8,7) >10 57,1 (28,6) в г а б…”

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Do cerebral microbleeds increase the risk of hemorrhagic complications of thrombolytic therapy?

Polyakova

Arablinsky

Левин

2016

Z. nevrol. psikhiatr. im. S.S. Korsakova

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The role of the cerebral microbleeds (CMB) as a potential predictor of hemorrhagic complications of thrombolytic therapy is discussed. CMB are small perivascular hemosiderin deposits in the brain detected by magnetic resonance imaging in gradient echo T2* or SWi sequences. They are associated (along with leukoaraiosis or lacunes) with cerebral microangiopathies. Most often CMB are associated with hypertensive arteriopathy (the main cause of CMB localization) or cerebral amyloid angiopathy (the main cause of cerebral CMB). Despite the controversies of recent data, most of researchers agree that thrombolytic therapy in patients with multiple CMB increases the risk of hemorrhagic complications. neuroimaging diagnosis of CMB may be important in making decision for thrombolytic therapy.

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Preexisting Cerebral Microbleeds on Susceptibility-Weighted Magnetic Resonance Imaging and Post-Thrombolysis Bleeding Risk in 392 Patients

Abstract: Background and Purpose-The question whether cerebral microbleeds (CMBs) visible on MRI in acute stroke increase the risk for intracerebral hemorrhages (ICHs) or worse outcome after thrombolysis is unresolved.

Cited by 59 publications

References 25 publications

Younger Stroke Patients With Large Pretreatment Diffusion-Weighted Imaging Lesions May Benefit From Endovascular Treatment

Younger Stroke Patients With Large Pretreatment Diffusion-Weighted Imaging Lesions May Benefit From Endovascular Treatment

Number of Cerebral Microbleeds and Risk of Intracerebral Hemorrhage After Intravenous Thrombolysis

Do cerebral microbleeds increase the risk of hemorrhagic complications of thrombolytic therapy?

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